AHIP Final Exam & Practice Exam | 2026/2027 Edition –135 Actual Exam Questions with Correct Answers

AHIP Final Exam & Practice Exam | 2026/2027 Edition –135 Actual Exam Questions with Correct Answers
Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not sure about
what type of plan designs are available through this program. What should you tell him about the types
of health plans that are available through the Medicare Advantage program? - ANS They are Medicare
health plans such as HMOs, PPOs, PFFS, SNPs, and MSAs
(W) Mr. Wells is trying to understand the difference between Original Medicare and Medicare
Advantage. What would be a correct description? - ANS Medicare Advantage is a way of covering all of
the Original Medicare benefits through private health insurance companies.
During a sales presentation in Ms. Sullivan's home, she tells you that she has heard about a type of
Medicare health plan known as Private Fee-for-Service (PFFS). She wants to know if this would be
available to her. What should you tell her about PFFS plans? - ANS A PFFS plan is one of various types of
Medicare Advantage plans offered by private entities and she may enroll in one if it is available in her
area.
(W) Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage.
What should you tell her? - ANS Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll
in Medicare Advantage
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying
his Part B premium. He would like to enroll in a Medicare Advantage (MA) plan and is still covered by
Part A. What should you tell him? - ANS He is not eligible to enroll in a Medicare Advantage plan until
he re-enrolls in Medicare Part B
(W) Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan several years ago. Her doctor
recently confirmed a diagnosis of end-stage renal disease (ESRD). What options does Mrs. Billings have
in regard to her MA plan during the next open enrollment season? - ANS She may remain in her ABC MA
plan or enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in her
area
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access
providers. What should you tell him? - ANS In most Medicare Advantage HMOs, Mr. Kumar must obtain
his services only from providers who have a contractual relationship with the plan (except in an
emergency).
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers she can
go to for her health care. What should you tell her? - ANS Mrs. Ramos can obtain care from any
provider who participates in Original Medicare, but generally will be charged a lower co-payment if she
goes to one of the plan's preferred providers.
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has received under
Original Medicare, but he would like to know more about Medicare Advantage Special Needs Plans
(SNPs). What could you tell him? - ANS SNPs have special programs for enrollees with chronic
conditions, like Mr. Sinclair, and they provide prescription drug coverage that could be very helpful as
well
(W) Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from his
investments. He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). His friend has
mentioned that the SNP charges very low cost-sharing amounts and Mr. Greco would like to join that
plan. What should you tell him? - ANS SNPs limit enrollment to certain sub-populations of beneficiaries.
Given his current situation, he is unlikely to qualify and would not be able to enroll in the SNP.
(W) Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and
paid taxes during that entire period. She is concerned that she will not qualify for coverage under part A
because she was not born in the United States. What should you tell her? - ANS Most individuals who
are citizens and over age 65 are covered under Part A by virtue of having paid Medicare taxes while
working, though some may be covered as a result of paying monthly premiums.
(W) Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security
Administration and has been receiving disability payments. He is wondering whether he can obtain
coverage under Medicare. What should you tell him? - ANS After receiving such disability payments for
24 months, he will be automatically enrolled in Medicare, regardless of age.
(W) Mr. Davis is 49 years old and has been receiving disability benefits from the Social Security
Administration for 12 months. Can you sell him a Medicare Advantage or Part D Prescription Drug
policy? - ANS No, he cannot purchase a Medicare Advantage or Part D policy because he has not
received Social Security or Railroad Retirement disability benefits for 24 months.
(W) Ms. Henderson believes that she will qualify for Medicare coverage when she turns 65, without
paying any premiums, because she has been working for 40 years and paying Medicare taxes. What
should you tell her? - ANS In order to obtain Part B coverage, she must pay a standard monthly
premium, though it is higher for individuals with higher incomes
(W) Mr. Diaz continued working with his company and was insured under his employer's group plan
until he reached age 68. He has heard that there is a premium penalty for those who did not sign up for
Part B when first eligible and wants to know how much he will have to pay. What should you tell him? -
ANS Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan.
(W) Mrs. Peňa is 66 years old, has coverage under an employer plan and will retire next year. She heard
she must enroll in Part B at the beginning of the year to ensure no gap in coverage. What can you tell
her? - ANS She may enroll at any time while she is covered under her employer plan, but she will have a
special eight-month enrollment period that differs from the standard general enrollment period, during
which she may enroll in Medicare Part B
(W) Mrs. Kelly is entitled to Part A, but is not yet enrolled in Part B. She is considering enrollment in a
Medicare health plan. What should you advise her to do before she will be able to enroll into a Medicare
health plan? - ANS In order to join a Medicare health plan, she also must enroll in Part B
Mrs. Park has a low, fixed income. What could you tell her that might be of assistance? - ANS She
should contact her state Medicaid agency to see if she qualifies for one of several programs that can
help with Medicare costs for which she is responsible
(W) Mr. Yu has limited income and resources so you have encouraged him to see if he qualifies for some
type of financial assistance. Mr. Yu is not sure it is worth the trouble to apply and wants to know what
the assistance could do for him if he qualifies. What could you tell him? - ANS He might qualify for help
with Part D prescription drug costs and help paying Part A and/or Part B premiums, deductibles, and/or
costsharing.
(W) Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when he turns
66. He wants to understand the health care costs he might be exposed to under Medicare if he were to
require hospitalization as a result of an illness. In general terms, what could you tell him about his costs
for inpatient hospital services under Original Medicare? - ANS Under Original Medicare, there is a single
deductible amount due for the first 60 days of any inpatient hospital stay, after which it converts into a
per-day amount through day 90. After day 90, he would pay a daily amount up to 60 days over his
lifetime, after which he would be responsible for all costs

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